TORT AND EVIDENCE LAW—A SPHINX WITHOUT A SECRET: THE COLLATERAL SOURCE RULE AND MANDATORY HEALTH INSURANCE IN MASSACHUSETTS

This Note argues that in the Commonwealth of Massachusetts the collateral source rule, as applied to health insurance reimbursement, is outdated and is more harmful than beneficial. Part I provides an overview of the notion of compensation in negligence cases and explains the origins and purpose of the collateral source rule. Part II discusses the reasons for the discrepancy between medical bills and insurance write-offs, and their application in Law v. Griffith. Part III touches upon the current tendency toward abrogation of the collateral source rule in various other states. Part IV discusses what makes Massachusetts unique with regard to health insurance. Part V analyzes the shortcomings of the collateral source rule. The Author proposes that the state legislature abrogate the rule as applied to medical payments by health insurance companies, and make such evidence available at trial

TORT AND EVIDENCE LAW—A SPHINX WITHOUT A SECRET: THE COLLATERAL SOURCE RULE AND MANDATORY HEALTH INSURANCE IN MASSACHUSETTS

This Note argues that in the Commonwealth of Massachusetts the collateral source rule, as applied to health insurance reimbursement, is outdated and is more harmful than beneficial. Part I provides an overview of the notion of compensation in negligence cases and explains the origins and purpose of the collateral source rule. Part II discusses the reasons for the discrepancy between medical bills and insurance write-offs, and their application in Law v. Griffith. Part III touches upon the current tendency toward abrogation of the collateral source rule in various other states. Part IV discusses what makes Massachusetts unique with regard to health insurance. Part V analyzes the shortcomings of the collateral source rule. The Author proposes that the state legislature abrogate the rule as applied to medical payments by health insurance companies, and make such evidence available at trial

Periodontal splinting – an adjunct to periodontal therapy

Progressive loss of clinical level of attachment and bone destruction, which often are result of spent periodontal disease, inevitably lead to increased mobility of the teeth. Other causes of tooth mobility are occlusion trauma, atypical root system, iatrogenic shortened roots after an apical osteotomy, excessive strain during orthodontic treatment and root resorption. Increased tooth mobility adversely affects the patient's function, aesthetics and comfort. Splints are used to overcome these problems

Application of autogenous platelet-rich plasma in periodontology

INTRODUCTION:Autogenous platelet-rich plasma (PRP) is a platelet-rich substance obtained after specific processing of peripheral blood.AIM:The purpose of the present study is to describe and examine the autogenous platelet-rich plasma and its application in periodontology.DISCUSSION:In the last decade, PRP has gained wide popularity and is used in a variety of fields of medicine. The implementation of PRP is basically a regenerative procedure using an autogenous graft. Therefore, it is believed that there is no danger of genetic interference, sensitization, or any kind of disease transmission. Platelet-rich plasma therapy is a safe and effective option with no known risks or side effects. In the last decade or two, the amount of published studies focused on the joined use of barrier membranes and bone repair materials with PRP has increased. One of the main benefits of using PRP to administer damaged tissues is that it activates and releases growth factors, which can enhance collagen and elastin formation by fibroblasts, boost blood supply and metabolism in the affected area, as well as help promote angiogenesis (the formation of new blood vessels). In this way, PRP therapy can effectively restore lost tissue.CONCLUSION:The presented study shows that the implementation of autogenous PRP is an innovative method for periodontal regenerative therapy based on the fact that regenerative therapy methods show different success rates and different long-term results, depending on the materials that are used

DIAGNOSTICAL VALUE OF LIQUOR CHANGES IN BRAIN STROKE PATIENTS

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Thermo-Fluid Effects Associated with Modelling Subscale Automotive Heat Exchangers

Automotive components are tested extensively in wind tunnels by automotive manufacturers and race teams. This is usually achieved using an accurate scale model representation of the component within the wind tunnel. Automotive heat exchangers, however, are comprised of numerous intricate geometries and are therefore impractical to produce at model scale. Instead they are simply modelled as pressure drops, achieved using a thin mesh or honeycomb of known porosity. Most commercial computational fluid dynamics solvers ignore the geometry of the heat exchanger and instead model it as a discontinuity with a known pressure drop and heat transfer. The pressure drop across an automotive heat exchanger, however, was found to vary with both the coolant temperature and the angle of inclination of the heat exchanger. This thesis initially presents a relationship between the pressure drop coefficient and the inclination angle for varying media porosities. Mathematical relationships for inclination angles of 0°, 15°, 30° and 45°. were derived relating this pressure drop coefficient to the porosity of the media. Weighted least squares is proposed over ordinary least squares when obtaining the Forchheimer equation coefficients from experimental measurements. Investigation extends into the thermo-fluid effects on a full scale automotive heat exchanger when inclined at 0 °, 15°, 30° and 45°. It was found, depending on the angle, that there was a difference in the pressure drop of up to 10% between the unheated and heated (100 C) heat exchanger. Based on the proposed mathematical relationship, this correlated to a 4% decrease in porosity in order to accurately model the automotive heat exchanger at subscale. The thesis concludes with experimental and numerical investigation into the heat transfer on a hydrodynamically and thermally developing ow within a radiator channel. Laser doppler anemometry measurements recorded a 1.5% increase in the centreline velocity compared to 0.8% obtained from numerical simulation

Markers of inflammation in patients with psoriasis vulgaris and psoriatic arthritis

Introduction: The pathogenesis of psoriasis is complex. Genetic factors have a basic role, followed by immunological disturbances, which have been found to provoke a chronic inflammatory process affecting the skin and joints. The study aimed to establish and analyze the relationship between the inflammatory manifestations and vitamin D status in the patients with psoriasis.Patients and methods: We investigated 113 patients with moderate or severe psoriasis, divided in two groups for analysis: presence of psoriasis without psoriatic arthritis (n=73) and with psoriatic arthritis (n=40). Clinical data for inflammation were assessed by Psoriasis Area and Severity Index (PASI). At hospital admission samples were collected for C-reactive protein (CRP) and blood count, as well as for 25-hydroxyvitamin D, 25(OH)D. The serum levels of 25(OH)D were tested with immune fluorescent method in 92 patients.Results: The patients with psoriatic arthritis compared to psoriatic patients without arthritis had higher C-reactive protein (31.77 30.61 mg/l vs. 4.13 4.19 mg/l, p<0.0001) and PASI (35.20 11.31 vs. 28.82 12.51, p=0.012) but lower 25(OH)D (10.66 8.73 ng/ml vs. 12.98 6.23 ng/ml, p=0.004). The significant correlation was found between the level of CRP and 25(OH)D, r= -0.2631 (p=0.012) and CRP and PASI, r=0.1993 (p=0.036).Conclusion: The serum level of CRP and 25(OH)D, the vitamin D deficiency respectively, could be accepted as markers for worse health condition according to the clinical manifestations of psoriasis, as well as the comorbid diseases

Saliva application in oral and systemic diseases

Saliva is a noninvasive and accessible biofluid that permits early detection of oral and systemic diseases. Changes in saliva reflect the alterations in the blood and thus making saliva a suitable diagnostic tool. The use of saliva has many advantages, including simple and non-invasive sampling and easy, low-cost storage.Today salivary diagnostics is a promising tool for diagnostic processes and clinical monitoring. Saliva is used to detect illicit drugs, alcohol, to measure hormone levels, and in the diagnosis of wide range systemic diseases such as cardiovascular, infectious, renal, endocrine diseases, some types of cancer as well as nonsystemic oral diseases.The current review presents a critical overview of saliva as a promising tool for the development of valuable salivary biomarkers, their relevance to the prognosis, diagnosis and management of systemic and oral diseases. Development of point-of-care testing based on saliva samples as a screening tool will also support the diagnostic process in near future

Vitamin D status in patients with psoriasis

Introduction: Vitamin D may act as immune modulator in psoriasis and be related with disease characteristics. Our study aimed to evaluate the vitamin D status in patients admitted for diagnostics or exacerbation of psoriasis.Material and methods: 92 patients (50 male, 42 female, mean age 55 years) were included in analysis. Disease severity was assessed by Psoriasis Area and Severity Index (PASI). Type of disease was classified according to age at presentation as early (up to 40 years) and late (above 40 years). Serum levels of 25-hydroxyvitamin D, 25(OH)D, were tested with immune fluorescent method (ADVIA Centaur Vitamin D Total, Siemens).Results: The mean level of 25(OH)D in psoriatic patients was 12.07 ng/ml (30.18 nmol/l), found at low limit of insufficiency; related 95% CI range was 10.55 - 13.60 ng/ml (26.38 - 33.99 nmol/l). A total of 45 of 92 patients (48.9%) had vitamin D insufficiency (defined as 25 (OH) D level of 10 to 30 ng/ml), 44 patients (47.82%) had deficiency (< 10 ng/ml) and only in 3 patients 25(OH)D was assessed at level of sufficiency. Vitamin D level correlate with PASI (r=-0.508), but does not correlate with C-reactive protein. No significant difference in vitamin D status was observed in patients with obesity and early type 1 psoriasis.Conclusion: High prevalence (47.83%) of vitamin D deficiency in patients with moderate and severe psoriasis suspects the role of vitamin D in pathogenesis of disease exacerbation. Vitamin D therapeutic supplementation needs to be clarified by further studies

Basic methods for investigating and proving sickle-cell anemia

Въведение: Сърповидно-клетъчната анемия (СКА) е генетично детерминирано заболяване, представляващо сериозен обществен здравен проблем не само за страните с традиционно висока честота (Африка, Азия, Америка, Средиземноморие), но и за множество от европейските страни, където се наблюдава непрекъснато нарастване на честотата на това заболяване. Цел: Да представим методи, използвани за скриниране и диагноза на СКА. Дискусия: Методите, използвани при скриниране и диагностициране на СКА са два основни типа: рутинни и високо специализирани лабораторни методи. Рутинните тестове включват ПКК, биохимични показатели за доказване на хемолиза in vivo, изследване на урина, както и скриниращите тестове за доказване наличието на HbS - тестове за разтворимост, тестове, предизвикващи промяна във формата на еритроцитите и др. От изключително значение за потвърждаване на диагноза е използването на високо специализирани техники за разделяне на белтъци като електрофореза и високоефективна течна хроматография (HPLC), определящи абнормните хемоглобинови варианти. За нуждите на пренаталната диагностика се използва и ДНК анализ за доказване на точкова мутация в гена за бета веригата на глобиновата молекула. Заключение: Необходимо е да се познават различните видове методи за скриниране и диагноза на СКА, за да е максимално ефективен и бърз диагностичният процес при това разпространено и не рядко тежко протичащо наследствено заболяване.Introduction: The sickle-cell anaemia (SCA) is a genetically determined disease, that is a major public health issue amongst not only the countries where it is traditionally quite common (Africa, Asia, America and the Mediterranean), but also the majority of European countries, where a significant increase of the frequency of the disease is observed. Aim: To present methods used for screening and diagnose of SCA. Discussion: The methods used for screening and diagnose of SCA can be classified into two main categories - routine ones and highly specialised laboratory methods. The routine tests include complete blood count, biochemical parameters to prove in vivo haemolysis, urine tests and the screening tests for presence of HbS e.g. sickling tests and solubility tests. In order to confirm the diagnosis of SCA the usage of protein separation techniques such as electrophoresis and high-performance liquid chromatography (HPLC) for detection of abnormal hemoglobin variants is of high importance. Concerning prenatal diagnostics DNA analysis is also used for detection of point mutation in the fetus beta gene of globin molecule. Conclusion: In order to ensure with maximum of effectiveness the diagnostic process of this common hereditary disease, a good knowledge of all available screening and diagnostic methods is needed